jeudi 23 juillet 2015

Create sequence partitioned by multiple columns and contiguous date

I'm trying to figure out how to create a sequence partitioned by multiple columns, where the sequence must reset once another (date based) column is not contiguous.

Problem: Hospital ADT (Admission/Discharge/Transfer) events occur at a particular point in time, but we want to turn these events into activities which have a duration (timespan), i.e. we have the start date, but don't have the end date, which is based on the next appropriate ADT event. We have done this in code, but also want to do it in SQL to improve performance. e.g. find patients who have spent more than 48 hours in ICU.

There are six different levels of site locations we want to record the duration of: facility, point of care, building, floor, room and bed.

Example:

Stream  Event  Started           Facility    PointOfCare  ...
1       1      2015-01-01 09:05  Hospital-A  ICU           
1       2      2015-01-02 13:10  Hospital-A  WARD-1
2       3      2015-02-10 12:00  Hospital-A  ICU           
2       4      2015-02-11 12:00  Hospital-A  ICU
2       5      2015-02-12 04:30  Hospital-A  WARD-2

So for each event we want to know how long they were in each particular site location. The end dates of the last activity in each stream are either null (still an inpatient) or the date patient was discharged.

Here's my current solution:

-- Create a sequence for each site location
INSERT INTO ADT_Activity_Sequence
SELECT 
  [Stream], 
  [Event],
  [Started],
  [Facility], 
  ROW_NUMBER() OVER (PARTITION BY [Stream], 
    ISNULL([Facility], [Event]) 
    ORDER BY [Started]) AS [FacilitySequence], 
  [PointOfCare], 
  ROW_NUMBER() OVER (PARTITION BY [Stream], 
    ISNULL([Facility], [Event]), 
    ISNULL([PointOfCare], [Event]) 
    ORDER BY [Started]) AS [PointOfCareSequence]
  -- and so on for all site locations
FROM ADT_Event
INNER JOIN ADT_Stream ON ADT_Event.Stream = Stream.Id

Example:

Stream  Event  Started           Facility    FacilitySequence  PointOfCare  PointOfCareSequence ...
1       1      2015-01-01 09:05  Hospital-A  1                 ICU          1 
1       2      2015-01-02 13:10  Hospital-A  2                 WARD-1       1
2       3      2015-02-10 12:00  Hospital-A  1                 ICU          1
2       4      2015-02-11 12:00  Hospital-A  2                 ICU          2
2       5      2015-02-12 04:30  Hospital-A  3                 WARD-2       1

Then create duration from the sequences:

INSERT INTO ADT_Activity_Duration
SELECT 
    [Stream], 
    [Event],
    [Started],
    [Facility], 
    [Sequence].[FacilitySequence],
    (
        -- Find most recent activity which is the first in current sequence
        SELECT TOP 1 [FacilitySequence].[Started] 
        FROM [ADT_Activity_Sequence] [FacilitySequence]
        WHERE [FacilitySequence].[Stream] = [Event].[Stream] AND [FacilitySequence].[FacilitySequence] = 1 AND [FacilitySequence].[Started] <= [Event].[Started]
        ORDER BY [FacilitySequence].[Started] DESC
    ) AS [FacilityStarted],
    (
        -- Find first activity in next sequence as this activities end date
        -- Last activity returns null, so activity uses stream end date if set
        ISNULL((                
            SELECT TOP 1 [FacilitySequence].[Started]
            FROM [ADT_Activity_Sequence] [FacilitySequence]
            WHERE [FacilitySequence].[Stream] = [Event].[Stream] AND [FacilitySequence].[FacilitySequence] = 1 AND [FacilitySequence].[Started] > [Event].[Started]
            ORDER BY [FacilitySequence].[Started]), [Stream].[Ended])
    ) AS [FacilityEnded],
    [PointOfCare], 
    [Sequence].[PointOfCareSequence],
    (
        SELECT TOP 1 [PointOfCareSequence].[Started] 
        FROM [ADT_Activity_Sequence] [PointOfCareSequence]
        WHERE [PointOfCareSequence].[Stream] = [Event].[Stream] AND [PointOfCareSequence].[PointOfCareSequence] = 1 AND [PointOfCareSequence].[Started] <= [Event].[Started]
        ORDER BY [PointOfCareSequence].[Started] DESC
    ) AS [PointOfCareStarted],
    (
        ISNULL((
            SELECT TOP 1 [PointOfCareSequence].[Started]
            FROM [ADT_Activity_Sequence] [PointOfCareSequence]
            WHERE [PointOfCareSequence].[Stream] = [Event].[Stream] AND [PointOfCareSequence].[PointOfCareSequence] = 1 AND [PointOfCareSequence].[Started] > [Event].[Started]
            ORDER BY [PointOfCareSequence].[Started]), [Stream].[Ended])
    ) AS [PointOfCareEnded]
    -- and so on for all site locations
FROM ADT_Event AS [Event]
INNER JOIN [ADT_Stream] AS [Stream] ON [Event].[Stream] = [Stream].[Id]
INNER JOIN [ADT_Activity_Sequence] [Sequence] ON [Event].[Id] = [Sequence].[Event]

Example:

Stream  Event  Started           Facility    FacilitySequence  FacilityStarted  FacilityEnded     PointOfCare  PointOfCareSequence  PointOfCareStarted  PointOfCareEnded  ...
1       1      2015-01-01 09:05  Hospital-A  1                 2015-01-01 09:05 2015-01-03 12:00  ICU          1                    2015-01-01 09:05    2015-01-02 13:10  
1       2      2015-01-02 13:10  Hospital-A  2                 2015-01-01 09:05 2015-01-03 12:00  WARD-1       1                    2015-01-02 13:10    2015-01-03 12:00
2       3      2015-02-10 12:00  Hospital-A  1                 2015-02-10 12:00 <NULL>            ICU          1                    2015-02-10 12:00    2015-02-12 04:30
2       4      2015-02-11 12:00  Hospital-A  2                 2015-02-10 12:00 <NULL>            ICU          2                    2015-02-10 12:00    2015-02-12 04:30
2       5      2015-02-12 04:30  Hospital-A  3                 2015-02-10 12:00 <NULL>            WARD-2       1                    2015-02-12 04:30    <NULL>

My problem lies when the contiguous date sequence is broken, which happens when a patient is transferred from any site location, and then transferred back again, all within the same stream:

Stream  Event  Started           Facility    PointOfCare  ...
3       1      2015-03-01 09:05  Hospital-A  ICU           
3       2      2015-03-02 13:10  Hospital-A  WARD-1
3       3      2015-03-02 10:00  Hospital-A  ICU           

Example:

Stream  Event  Started           Facility    FacilitySequence  PointOfCare  PointOfCareSequence ...
3       1      2015-03-01 09:05  Hospital-A  1                 ICU          1 
3       2      2015-03-02 13:10  Hospital-A  2                 WARD-1       1
3       3      2015-03-02 10:00  Hospital-A  3                 ICU          2

Note event #3 has a point of care sequence of 2, which is incorrect, it needs to be reset back to 1 due to event #2 being in a different location.

I've been going around in circles for a while now :) so any help appreciated, thanks!

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